At the end of the 1970s and in the
early 1980s a small number of enthusiasts began to develop and
expand day surgery in their own hospitals. Indeed, a few became
evangelists for this approach to treatment, travelling widely and
promoting its benefits at district, regional and national meetings.
Two of these, Dr Tom Ogg and Professor Paul Jarrett, increasingly
found themselves speaking at the same events. They were both
concerned that despite good, published evidence on paediatric day
surgery that the majority of the British medical and nursing
establishment remained apathetic with regards to the expansion of
day surgery. Consequently, they believed that a coordinated
approach to the promotion of day surgery might be beneficial.
One Saturday in August 1988, the
pair met at the Garden House Hotel in Cambridge. During an
excellent and well lubricated lunch they decided that the way
forward was to form a day surgery association which, to maximise
its impact, should be multidisciplinary. Now that was the easy
part. However, funding was required to make their idea a reality.
Fortunately, Paul Jarrett was then a director of a healthcare
company and he convinced his fellow directors to sponsor a two-day
meeting to discuss the formation of an association. The meeting was
held on the 22nd and 23rd April 1989, at the Stafford Hotel in St
James, London - a hotel better known for accommodating Elizabeth
Taylor and the Trumps than as a birthplace for medical
associations. Those attending, apart from Jarrett (consultant
general surgeon, Kingston) and Ogg (consultant anaesthetist,
Cambridge) were Dr Tony Davenport (retired anaesthetist, Northwick
Park), Dr Jean Millar (consultant anaesthetist, Oxford), Dr Peter
Simpson (regional medical officer, Liverpool), Mrs Sarah Penn
(nursing sister, Barnet Hospital) and Dr Chris Ward (consultant
plastic surgeon, Charing Cross Hospital). Mr Brendan Devlin and
Professor Sir Miles Irvin sent their support and apologies. All at
this meeting agreed that the formation of a multidisciplinary
association would be beneficial. Plans for funding, promotion,
annual national meetings and the development of a journal were
extensively discussed. Predictably, perhaps, the decision on the
name of the new association took a disproportionate amount of time.
Eventually it was whittled down to six alternatives of which two
were favourites - the British Association of Surgery and Outpatient
Investigation (SOPI) and the British Association of Day Surgery
(BADS). SOPI seemed inappropriate and so the Association was named
BADS. Paul Jarrett was elected chairman, Tom Ogg, chairman elect,
Jean Millar secretary, Tony Davenport journal editor, and Peter
Simpson, Chris Ward and Sarah Penn committee members. Basically the
original aims of BADS were:
- To encourage the expansion of day surgery
- To promote education and high quality
treatment
- To conduct research and publish the
findings
- To organise meetings, seminars lectures and
conferences
- To provide advice on the construction and management of
day units
- To maintain high standards of surgical, anaesthetic and
nursing care
- To organise a day surgery reference
library
A further meeting in July 1989, at the Churchill Hospital, Oxford
day unit confirmed funding from ICI Pharmaceuticals for a national
meeting. However, no publisher had been found to produce a journal
at no cost to the Association. The first annual meeting entitled
"The Future of British Day Care Surgery - a multidisciplinary
approach" was held at the Royal Society of Medicine, London on
Friday, 1st June 1990. Although the lecture hall, with 200 seats,
was fully booked before the meeting, a further 50 people turned up
on the day and had to be housed in another room with piped sound.
Here was the evidence that there was indeed a need for relevant
education and guidance on all aspects of day surgery.
Amongst the delegates was Baroness
Julia Cumberledge (later Health Minister and spokesman in the
Lords) a founding member and, over the years, a great supporter of
the Association. One of the guest speakers was Professor Sir Liam
Donaldson now Chief Medical Officer. At this meeting there was
strong support for an association and BADS was inaugurated. The
annual membership fee was set at the princely sum of £5. The
Association soon became the voice of British Day Surgery and
participated in the publication of many reports. From 1990 to 1997,
various documents were published in conjunction with the Audit
Commission (on several occasions), the NHS Management Executive
(Value for Money Unit), Royal College of Surgeons of England, the
Royal College of Anaesthetists, Welsh Health Planning, Caring for
Children in the Health Services Research Unit (Aberdeen
University), the NHS Estates Section and the Department of Health.
Amongst the authors of these reports are many well-known names,
including Jarrett, Ogg, Devlin, Penn, Ralphs and Wilkinson.
Certainly many organisations were keenly interested in the
development of safe day surgery and many members of the BADS
committee travelled the length and breadth of lecturing, attending
crucial formative meetings and discussing the relevance of their
own research findings. All the essential references required to
establish day surgery have recently been brought together in the
2004 index to volumes 1-13 of the Journal of One-day Surgery.
The committee of the Association,
with new secretary Sarah Penn, met quarterly either in the
postgraduate medical centre at Barnet Hospital or a hotel next to
the South Mimms service area on the M25. At this stage, the
Association had no office nor paid secretarial assistance and it
was administered from the officers' homes mainly at their personal
expense. Nevertheless, such was the enthusiasm of the BADS
committee that no scheduled meeting was ever cancelled because of
the weather, lack of interest or more pressing clinical
commitments. Membership fees and profits from annual meetings were
put aside for several years, to build a fund for the future so that
an office, a secretary and proper charity status could eventually
be achieved. However, despite the Association working on a
shoestring and goodwill, membership grew and the first constitution
was published. Then BADS secured the services of Newton Mann
Limited to publish the Journal of One-day Surgery free to members
of the Association. The editor was the enthusiastic late Dr Tony
Davenport and volume 1, number 1 of this journal was available for
the second annual meeting at the University of Birmingham Medical
School on 21st June 1991. There were then around 400 members and
the membership fees were increased to £10 in 1991-92, although the
early meetings were heavily subsidised by the pharmaceutical
industry. For example, the cost of attending the Birmingham
meeting, including lunch, was only £10! Similarly in May 1992 the
annual meeting at the Royal College of Surgeons cost £20 including
a year's membership. At the London meeting Tom Ogg took over as
Chairman and the following year introduced the first two-day annual
meeting. This allowed a social event to be held on the evening of
the first day. The meeting was held at the Corn Exchange in
Cambridge on the 2nd and 3rd July 1993. Delegates were treated to
an organ recital at Kings College Chapel, dinner was then served on
the college lawns and accommodation was available in Downing
College. It could be said that BADS had come of age.
After the 1994 annual meeting at
Keele University, the late Brendan Devlin became Chairman. Over the
next two years she and the new secretary, David Ralphs,
consolidated the basis of the Association. A carefully worded and
legally correct constitution was drawn up, full charity status
achieved and a permanent office based at the Royal College of
Surgeons obtained. The post of Chairman was elevated to that of
President. [David Ralphs was also instrumental in designing the
BADS logo during this time,Ed]. Annual conferences in Eastbourne
(1995) and Glasgow (1996) followed. Much of the administrative hard
work for these large conferences was performed by Mr Neil Strachan
of Kite Communications. Then in April 1997 BADS, a founding member
of the International Association for Ambulatory Surgery (IAAS),
hosted the 2nd International Congress on Ambulatory Surgery at the
Queen Elizabeth II centre in London in conjunction with its own
annual meeting. Over 1500 delegates attended and the great success
of this event was due to the hard work put in by the Congress
President, Tom Ogg and his energetic local organising committee of
Paul Jarrett, Paul Baskerville, David Ralphs and Sarah Penn
(President BADS, 1996-98). For the record Jarrett and Ogg
eventually became Presidents of the IAAS, a multidisciplinary
organisation involving over 35 countries. Subsequently, the
Association has continued to develop and has gained a number of
significant achievements. These include the election of Sarah Penn
as the first female and nurse president - a first and still unique
appointment amongst day surgery organisations worldwide. More
recently, the Association has established a permanent office
manager and has taken on the organisation of its own meetings.
Notably, several other of the early members, including David
Ralphs, Peter Simpson , Paul Baskerville and Jill Solly, have gone
on to become President. Any organisation should, of course, always
look to the future. However, it is sometimes of interest to learn
how things evolved. We hope that this article fulfils that purpose
for the first years of BADS. Despite the hours of hard grind we
would undoubtedly do the same again if only for the many hours of
enjoyment in the company of our multidisciplinary colleagues. It is
indeed rewarding for us to see that BADS continues to spread the
word of day surgery even in troubled times.
This information is largely taken from an article by
PROFESSOR PAUL EM JARRETT
Professor of Day Surgery & Consultant Surgeon, Kingston
Hospital NHS Trust. and
Dr TOM OGG
Retired Director Day Surgery & Consultant Anaesthetist.
Addenbrookes NHS Trust, Cambridge
